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Ultrasonography as a tool

in predicting the severity

of dengue
fever in childrena useful
aid in a developing
Dr. H. Raddy Irmawan, Sp.A
Presented by:
Lili Susanti-112014250


Title: Ultrasonography as a tool in
predicting the severity of dengue fever
in childrena useful aid in a developing
Author: K. R. Bharath Kumar Reddy &
Ramesh R. Laksmana & Basavaraja G.
Veerappa & Shivananda
Date of Publication: 3 March 2013
Published: Springer-Verlag Berlin
Heidelberg 2013




Materials and Methods

Materials and Methods

Materials and Methods

All US abdomen and pelvis scans
were carried out with real-time US
scanners using 3.5- and 5-MHz
Abdominal scanning was done after
6h of fasting to allow better
distention of gallbladder.

Severity of illness was graded as

per WHO criteria and sonography
findings were correlated to the
grade of illness.

Statistical Analysis



Table 7 Sonographic findings in children based on outcome of

severe dengue fever (grades III and IV), n=176

Gallbladder wall thickening was found in 75% of
our children with confirmed dengue fever
(Sensitivity 46.2% and specificity 55.7%).
Studies have used gallbladder wall thickening
(GBWT) as a marker to prognosticate dengue
Hepatic subcapsular fluid finding in 26% of
children (Sensitivity 89.6% and specificity 97.6%)
an important sign of severe disease.
76 % of children with dengue fever shock
syndrome (grade IV) demonstrated fluid in the
pericholecystic area, thus being able to
significantly predict (P=0.002) a worse prognosis
and mortality.

Intraparenchymal fluid in the liver significantly
predicted a higher grade of illness and also
mortality (P<0.001) with 64% of children who died
having this finding (specificity of 99.7% and
sensitivity of 96%)
71% of children who died had splenomegaly,
making it an important marker of possible
Perirenal fluid, peripancreatic fluid, splenic
subcapsular fluid collections and pericardial
effusion were found significantly higher in children
with a more severe illness and, thus, contribute in
determining the grade of the disease and its
subsequent management.

Ascitis and pleural effusion were
found in most of our patients
irrespective of the grade of illness,
although a higher incidence was
noted in those with grade III or grade
IV disease severity.
The critical feature noted in the
pathophysiology of dengue
hemorrhage fever is plasma leakage.

It should be noted that many such
features can be seen in the first week of
illness and hence can help in the early
detection of dengue fever, much earlier
than the serological confirmation using
IgM ELISA, which may be negative in the
first week of illness.
Gallbladder wall thickening can be
attributed to the decrease in intravascular
osmotic pressure.

This study demonstrates the importance
of abdominal US in dengue fever in aiding
the clinician in diagnosis, grading its
severity and judging the prognosis of the
child, even prior to obtaining serological
Thus, in a developing country where the
mortality due to dengue fever in children
remains high, and resources are limited,
an easily available tool such as US could
aid in management of the disease

Thank You